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Harapan BN, Harapan T, Theodora L, Anantama NA. From Archipelago to Pandemic Battleground: Unveiling Indonesia's COVID-19 Crisis. J Epidemiol Glob Health 2023; 13:591-603. [PMID: 37707715 PMCID: PMC10686963 DOI: 10.1007/s44197-023-00148-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to countries worldwide, including Indonesia. With its unique archipelagic geography consisting of more than 17,000 thousand islands, Indonesia faces unique complexities in managing the spread of the virus. Based on existing literature, this review article elaborates on key issues that have shaped Indonesia's COVID-19 response. The article begins by examining the early stages of the COVID-19 pandemic in Indonesia, along with the implementation of various preventive measures and the impact of the virus on public health. This article examines how Indonesia's socio-economic factors have generally influenced its healthcare system and further delves into the COVID-19 response strategies implemented by the Indonesian government and public health authorities as well as overall crisis preparedness. It discusses the actions taken to control the spread of the virus, including testing strategies and vaccination efforts. The difficulties encountered in implementing these measures are presented. In conclusion, this review article provides a comprehensive understanding of the COVID-19 crisis in Indonesia, covering facts on multiple dimensions ranging from the timeline of the pandemic to vaccination efforts, epidemiology, socio-economic implications, testing strategies, mobility patterns, public holidays, the impact of working from home, and the utilization of complementary and alternative medicine in addition to the standard of care for COVID-19. The insights gained from this article can complement future strategies for pandemic management and response in Indonesia and other countries facing similar challenges.
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Affiliation(s)
| | - Triswan Harapan
- Complementary Cardiovascular Clinic (CCV Clinic), Tangerang Selatan, Indonesia
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Schwarting J, Harapan BN, Lin X, Plesnila N, Terpolilli NA. Nimodipine Reduces Microvasospasms After Experimental Subarachnoid Hemorrhage. Stroke 2023; 54:2666-2670. [PMID: 37675614 DOI: 10.1161/strokeaha.123.043976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The only established pharmacological treatment option improving outcomes for patients suffering from subarachnoid hemorrhage (SAH) is the L-type-calcium channel inhibitor nimodipine. However, the exact mechanisms of action of nimodipine conferring neuroprotection after SAH have yet to be determined. More recently, spasms of the cerebral microcirculation were suggested to play an important role in reduced cerebral perfusion after SAH and, ultimately, outcome. It is unclear whether nimodipine may influence microvasospasms and, thus, microcirculatory dysfunction. The aim of the current study was, therefore, to assess the effect of nimodipine on microvasospasms after experimental SAH. METHODS Male C57Bl/6 N mice (n=3-5/group) were subjected to SAH using the middle cerebral artery perforation model. Six hours after SAH induction, a cranial window was prepared, and the diameter of cortical microvessels was assessed in vivo by 2-photon-microscopy before, during, and after nimodipine application. RESULTS Nimodipine significantly reduced the number of posthemorrhagic microvasospasms. The diameters of nonspastic vessels were not affected. CONCLUSIONS Our results show that nimodipine reduces the formation of microvasospasms, thus, shedding new light on the mode of action of a drug routinely used for the treatment of SAH for >3 decades. Furthermore, L-type Ca2+ channels may be involved in the pathophysiology of microvasospasm formation.
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Affiliation(s)
- Julian Schwarting
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Now with Department of Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany (J.S.)
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Germany (J.S., B.N.H., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
| | - Biyan Nathanael Harapan
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Germany (J.S., B.N.H., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
| | - Xiangjiang Lin
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
| | - Nicole A Terpolilli
- Institute for Stroke and Dementia Research (ISD) (J.S., B.N.H., X.L., N.P., N.A.T.)
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Germany (J.S., B.N.H., N.A.T.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (J.S., B.N.H., X.L., N.P., N.A.T.)
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Lin X, Khalin I, Harapan BN, Terpolilli NA, Schwarting J, Plesnila N. Perivascular Macrophages Mediate Microvasospasms After Experimental Subarachnoid Hemorrhage. Stroke 2023. [PMID: 37325921 DOI: 10.1161/strokeaha.122.042290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is characterized by acute and delayed reductions of cerebral blood flow (CBF) caused, among others, by spasms of cerebral arteries and arterioles. Recently, the inactivation of perivascular macrophages (PVM) has been demonstrated to improve neurological outcomes after experimental SAH, but the underlying mechanisms of protection remain unclear. The aim of our exploratory study was, therefore, to investigate the role of PVM in the formation of acute microvasospasms after experimental SAH. METHODS PVMs were depleted in 8- to 10-week-old male C57BL/6 mice (n=8/group) by intracerebroventricular application of clodronate-loaded liposomes and compared with mice with vehicle liposome injections. Seven days later, SAH was induced by filament perforation under continuous monitoring of CBF and intracranial pressure. Results were compared with sham-operated animals and animals who underwent SAH induction but no liposome injection (n=4/group each). Six hours after SAH induction or sham surgery, numbers of microvasospasms per volume of interest and % of affected pial and penetrating arterioles were examined in 9 standardized regions of interest per animal by in vivo 2-photon microscopy. Depletion of PVMs was proven by quantification of PVMs/mm3 identified by immunohistochemical staining for CD206 and Collagen IV. Statistical significance was tested with t tests for parametric data and Mann-Whitney U test for nonparametric data. RESULTS PVMs were located around pial and intraparenchymal arterioles and were effectively depleted by clodronate from 671±28 to 46±14 PVMs/mm3 (P<0.001). After SAH, microvasospasms was observed in pial arteries and penetrating and precapillary arterioles and were accompanied by an increase to 1405±142 PVMs/mm3. PVM depletion significantly reduced the number of microvasospasms from 9 IQR 5 to 3 IQR 3 (P<0.001). CONCLUSIONS Our results suggest that PVMs contribute to the formation of microvasospasms after experimental SAH.
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Affiliation(s)
- Xiangjiang Lin
- Institute for Stroke and Dementia Research (ISD) (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
| | - Igor Khalin
- Institute for Stroke and Dementia Research (ISD) (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
| | - Biyan Nathanael Harapan
- Institute for Stroke and Dementia Research (ISD) (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
- Department of Neurosurgery, Munich University Hospital, Germany (B.N.H., N.A.T., J.S.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
| | - Nicole Angela Terpolilli
- Institute for Stroke and Dementia Research (ISD) (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
- Department of Neurosurgery, Munich University Hospital, Germany (B.N.H., N.A.T., J.S.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
| | - Julian Schwarting
- Institute for Stroke and Dementia Research (ISD) (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
- Department of Neurosurgery, Munich University Hospital, Germany (B.N.H., N.A.T., J.S.)
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische University Munich, Germany (J.S.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research (ISD) (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (X.L., I.K., B.N.H., N.A.T., J.S., N.P.)
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Yoo HJ, Harapan BN. Chimeric antigen receptor (CAR) immunotherapy: basic principles, current advances, and future prospects in neuro-oncology. Immunol Res 2021; 69:471-486. [PMID: 34554405 PMCID: PMC8580929 DOI: 10.1007/s12026-021-09236-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/31/2021] [Indexed: 12/19/2022]
Abstract
With recent advances, chimeric antigen receptor (CAR) immunotherapy has become a promising modality for patients with refractory cancer diseases. The successful results of CAR T cell therapy in relapsed and refractory B-cell malignancies shifted the paradigm of cancer immunotherapy by awakening the scientific, clinical, and commercial interest in translating this technology for the treatment of solid cancers. This review elaborates on fundamental principles of CAR T cell therapy (development of CAR construct, challenges of CAR T cell therapy) and its application on solid tumors as well as CAR T cell therapy potential in the field of neuro-oncology. Glioblastoma (GBM) is identified as one of the most challenging solid tumors with a permissive immunological milieu and dismal prognosis. Standard multimodal treatment using maximal safe resection, radiochemotherapy, and maintenance chemotherapy extends the overall survival beyond a year. Recurrence is, however, inevitable. GBM holds several unique features including its vast intratumoral heterogeneity, immunosuppressive environment, and a partially permissive anatomic blood–brain barrier, which offers a unique opportunity to investigate new treatment approaches. Tremendous efforts have been made in recent years to investigate novel CAR targets and target combinations with standard modalities for solid tumors and GBM to improve treatment efficacy. In this review, we outline the history of CAR immunotherapy development, relevant CAR target antigens validated with CAR T cells as well as preclinical approaches in combination with adjunct approaches via checkpoint inhibition, bispecific antibodies, and second-line systemic therapies that enhance anticancer efficacy of the CAR-based cancer immunotherapy.
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Affiliation(s)
- Hyeon Joo Yoo
- Department of Internal Medicine V, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Biyan Nathanael Harapan
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University of Munich, 81377, Munich, Germany.
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Harapan BN, Frydrychowicz C, Classen J, Wittekind C, Gradistanac T, Rumpf JJ, Mueller W. No enhanced (p-) α-synuclein deposition in gastrointestinal tissue of Parkinson's disease patients. Parkinsonism Relat Disord 2020; 80:82-88. [PMID: 32971383 DOI: 10.1016/j.parkreldis.2020.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/15/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Neuronal alpha-synuclein (α-Syn) aggregation in the brain is believed to be a central component of the pathogenesis of Parkinson's disease (PD). α-Syn aggregates in the gastrointestinal tract have been suggested as a potential biomarker of PD that may even signal an early event of the Parkinsonian molecular pathology. However, studies further investigating this hypothesis have produced mixed results. OBJECTIVE To determine whether the prevalence of α-Syn- and serine 129-phosphorylated α-Syn (Ser129p-α-Syn) depositions detected in intestine from PD patients differed from that of non-Parkinsonian controls. METHODS In this retrospective study, we examined post-mortem small and large intestine samples of 25 PD patients and 20 age- and sex-matched controls without PD. Specimens were taken from archived paraffin-embedded tissue blocks. Immunohistochemical techniques were applied to detect α-Syn and Ser129p-α-Syn aggregates in situ. Immunoreactivity was quantified by a new approach that employed the detailed assessment of α-Syn- and Ser129p-α-Syn-positive morphological structures of the enteric nervous system (i.e., nerve fibers, myenteric and submucous plexus as well as ganglion cells). RESULTS α-Syn immunoreactivity was a common finding in intestinal tissues from PD patients and controls. Importantly, α-Syn and Ser129p-α-Syn immunoreactivity were significantly reduced in PD patients compared to controls in each of the morphological structures examined. CONCLUSIONS Immunohistochemical detection of intestinal α-Syn and Ser129p-α-Syn seems to be a frequent and potentially normal finding. Neither α-Syn nor Ser129p-α-Syn immunoreactivity may, therefore, be regarded as a molecular intestinal biomarker of PD pathology. Reduced intestinal α-Syn and Ser129p-α-Syn immunoreactivity in PD patients rather reflect PD-related neuronal degeneration.
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Affiliation(s)
| | | | | | | | | | | | - Wolf Mueller
- Department of Neuropathology, University of Leipzig, Germany
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